Background
Methods
Eligibility criteria
Information sources
Search strategy
Selection and data charting processes
Results
Selection of sources of evidence
Characteristics of sources of evidence
Name | Location | Description of Organization | Stage | Purpose |
---|---|---|---|---|
Integrated health system
| ||||
Baylor Scott & White Health [16] | Texas, U.S | Consists of 48 hospitals, 185 outpatient facilities, 26 surgery centers, 164 primary care clinics, 503 specialty clinics, and 30 pharmacies | Planning | Clinical decision making / quality improvement |
Denver Health [17] | Colorado, U.S | Consists of a hospital, 17 school health clinics, 9 primary care centers, and a trauma center | Planning | Clinical decision making / quality improvement |
Central Pennsylvania & Southern New Jersey, U.S | Consists of 8 hospitals, local primary care centers, specialists, and trauma centers | Active | Clinical decision making / quality improvement | |
Utah & Idaho, U.S | Consists of 22 hospitals, over 179 clinics, physician offices, and home-based care centers | Active | Clinical decision making / quality improvement | |
Johns Hopkins [26] | Maryland, U.S | Consists of 240 primary care providers | Active | Clinical decision making / quality improvement |
Colorado, U.S | Consists of 1200 physicians across 31 centers | Active | Research / clinical decision making | |
Northern California, U.S | Consists of 8000 physicians across 237 centers | Active | Research / clinical decision making | |
Southern California, U.S | Consists of 6000 physicians across 209 centers | Active | Research / clinical decision making / quality improvement | |
Washington, U.S | Consists of 31 medical centers | Active | Clinical decision making / quality improvement | |
New York, U.S | Consists of 6 inpatient locations, and 8 primary care and speciality clinics | Active | Clinical decision making / quality improvement | |
University of Utah [40] | Utah, U.S | An integrated health system consisting of 4 hospitals, 12 primary care clinics, 23 regional partners, and 3 specialty centers | Active | Quality improvement |
Wisconsin, U.S | An integrated health system with approximately 1500 physicians, and 45 primary care clinics with over 250,000 patients | Active | Clinical decision making / quality improvement | |
U.S | National network across the Veterans Health Administration consisting of over 1200 healthcare centers, including primary care | Active | Research / quality improvement | |
Research / data network
| ||||
United Kingdom | A network of 4 cities in North England collaborating with many organizations including NHS, hospitals, universities, and 550 primary care provider centers | Completed | Research / quality improvement | |
South Carolina, U.S | A network consisting of 7 of South Carolina's largest health systems and 3 research universities with a central data warehouse | Active | Research / quality improvement | |
Chicago, U.S | A network that supports clinical and translational research across Northwestern University departments, including clinical partners of Northwestern Memorial Healthcare Corporation, Ann and Robert H. Lurie Children's Hospital, and the Rehabilitation Institute of Chicago, and community partners including primary care clinics | Active | Research / quality improvement | |
Lucerne, Switzerland | A network consisting of partner organizations: the University of Lucerne, University of Zurich, Swiss TPH Basel, Zurich University of Applied Sciences, University of Neuchâtel, University of Lugano, and University of Applied Sciences and Arts of Southern Switzerland | Planning | Research | |
Europe | A network of 21 partner organisations from 10 EU member states focusing on primary care research | Active | Research / clinical decision making | |
Network of networks
| ||||
U.S | A network consisting of 19 healthcare systems across 13 states including Kaiser Permanente and Geisinger | Active | Research | |
U.S | A network consisting of 19 healthcare delivery systems, including integrated systems with primary care, from across the U.S. with the data hub at the Dartmouth Institute for Health Policy and Clinical Practice | Active | Research | |
U.S | A network with headquarters in Cambridge, Massachusetts that standardizes EHR data across 52 health systems in the U.S | Active | Research |
Integrated health systems
Research / data networks and networks of networks
Challenges and potential solutions
Challenges | Potential Solutions |
---|---|
Data | |
Use of a ‘mediation’ approach to data interoperability (i.e. standardization) allows for different EHR vendors to be linked, saves time and money from reorganizing the whole network, allows new data to easily be incorporated, and for flexibility with how the data is used [63]. Adapting interventions to fit existing EHRs to ease dissemination of findings [30]. Standardization of data and processes across systems [13]. | |
Lag in updated data including patient lists [15]. | |
Need to access data without the assistance of a data analyst [21]. | |
Organizational factors | |
Increasing awareness of LHS and developing a culture of learning and improving throughout organization [21]. | Embedding researchers within the healthcare system [13]. |
Initiatives to increase patient and family involvement, including the development of patient and family advisory councils, or allowing patients to access their data through secure patient portals [20]. | |
Use of better tools to reduce practice variability, including strategies to engage and help low-performing practices [44]. | |
Need to develop processes to assist in prioritizing learning across the organization [20]. | |
Research / quality improvement | |
Different initiatives to support quality improvement across the organization. For example: ○ Holding annual quality improvement conferences where project leaders can share their experiences, which are then collated to provide a library of quality improvement initiatives [16].○ A whiteboard in each clinic that lists all system-wide and clinic-specific quality improvement initiatives currently in progress at that location [17]. |